Preventive Care Strategies and Controversies Workshop

Description of Resource: At the University of Kansas School of Medicine, students complete an 8 week required Family Medicine clerkship during their 3rd year. They have weekly didactic sessions. This curriculum includes a 3-hour workshop designed to give students experience in making prevention recommendations to a variety of patients as well as a didactic session on the most controversial topics and the recommendations from various primary care and specialty groups. For the prevention workshop students are divided into 6 groups and given a patient case with a 30-minute "visit" time as well as a list of possible prevention activities and the amount of time each activity "costs." Each group discusses their patient and prioritizes a prevention plan based on the USPSTF guidelines, then each group presents their recommendations to the whole group. The controversies in screening session then allows for discussion of those areas in which screening recommendations may vary significantly across specialties. This curriculum includes a facilitators guide, the 6 patients cases, the prevention choices and a list of possible answers for each of the 6 cases. It also includes a controversies in screening powerpoint presentation.

Teaching Motivational Interviewing Using Standardized Patients

Description of Resource: EVMS provides an 8 week required family medicine clerkship where students practice skills in patient centered communication and motivational interviewing. They evaluate 2 or 3 standardized patients in a simulated patient-centered medical home each week. This submission includes curricular materials for a series of three acute care cases that involve a mother and step-daughter. The complete curriculum provides a menu of 18 cases covering a spectrum of acute processes, chronic disease management and preventive care.Standardized patient demographics vary across age and gender to provide a comprehensive learning experience. Each case is designed to cover aspects of the STFM core curriculum and emphasize the skills necessary to provide excellent care to patients, especially those with barriers to achieving optimal outcomes. Complementing the current curriculum, cases are designed for simulations, individual or small group discussions or role play. The curriculum in this submission includes preparatory readings for students and teaching points for educators and standardized patients. Material highlights case-specific motivational interviewing goals and effective patient-centered communication techniques to meet those goals.

Observed Patient Encounter (OPE)

Description of Resource: The Observed Patient Encounter focuses on clinical reasoning, encourages self-assessment, and increases direct observation of students during the Family Medicine clerkship. While in their preceptor's office, students video record a full encounter with a patient who presents with an acute complaint. The student records the history and physical, the precepting encounter, and the delivery of the assessment and plan to the patient. Students may record multiple encounters and choose the encounter that best represents their clinical skills, particularly their clinical reasoning. The recordings are then reviewed in a small group setting with 4-5 students and one faculty member. As the group watches each video, the presenting student leads with a brief self-evaluation and their peers and the tutor offer feedback. The faculty member evaluates the assignment using the Observed Patient Encounter Assessment form (Appendix A) and leads the group in a discussion. The utility of video feedback is well established. Numerous studies demonstrate the statistically significant, positive effect on interaction skills across multiple disciplines (Fukkink, Trienekens, and Kramer 2010). In medical education, video feedback has proven particularly helpful in teaching history taking skills, from teaching interviewing skills (Maguire et al. 1978), to evaluating communication skills (Irwin & Bamber 1984), to actually changing resident interview behavior (Bryson-Brockmann & Fischbein 1995). To date, no studies have endeavored to highlight the benefits of video feedback when teaching and refining clinical reasoning skills.

Coffee Talks: An Innovative Approach to Teaching Clinical Reasoning and Information Mastery to Medical Students

Description of Resource: "Coffee Talks" is a workshop started at Penn State College of Medicine in 2009 for all third year clerks rotating through our 4 week Family Medicine Clerkship. Seeking a novel approach to teaching Clinical Reasoning and Information Mastery, we established a case-based conference where students present a Clerkship case known to them but not the facilitators. The workshop includes 10-14 students and an inter-professional team of 2-4 faculty of clinicians and librarians with experience, interest and advanced training in these concepts. The thinking skills of medical students are enhanced by faculty-facilitated discussions of the cases during which the students formulate a working differential diagnosis that is assessed and modified after each segment of the presentation. This student-led process is collegial and non-threatening. In addition, each student is required to identify and answer a clinical question from any case seen during this clerkship, and to submit prior to the conference a 4-5 PowerPoint slide presentation utilizing the PICO format. These PICO presentations are reviewed by the faculty at the clinical site and by faculty at the workshop, and they are used as educational tools to highlight evidence based medicine (EBM) resources, proper formatting of clinical questions, and appropriate interpretation of guidelines and recommendations.

Telemedicine OSCE ("TeleOCSE"): Rural Diabetes

Description of Resource: There is a severe shortage of primary care physicians in the U.S., especially in rural areas. Telemedicine has the potential to address this shortage by making it easier for providers to connect with remote patients. To better prepare providers for this new practice mode, simulated telemedicine experiences should be incorporated in medical education. The Oregon Health & Science University (OHSU) Family Medicine clerkship telemedicine OSCE (TeleOSCE) places learners into the role of a rural physician consulting via telemedicine with a remote, rural patient. The TeleOSCE serves as a standalone experiential education activity during the required 5 week Family Medicine clerkship that exposes learners to a new model of rural care. It also logistically allows a clerkship to administer an OSCE activity to remote learners. The TeleOSCE can be easily adapted to meet the needs of different institutions and is administered using cost-effective, internet-based videoconferencing software. Materials included are the TeleOSCE case with checklist and implementation instructions as well as an informational guide with a video clip and setup guide.

Case Based Learning, Family Medicine Clerkship Didactic Session, Common Dermatoses

Description of Resource: This is a case based learning session on common dermatoses that can be used during the Family Medicine Clerkship (FMC). At the Florida International University Herbert Wertheim College of Medicine, the FMC is a required 8 week outpatient clinical experience consisting of approximately 20 students on each block. Students are in an outpatient clinic Monday through Thursday and have didactics on campus Fridays. This didactic session is led by one faculty member and may take from 1-2 hours (2 hours earlier in the third year and 1 hour in the later rotations). Contents of this posting include a facilitator guide, the core case excerpt from our syllabus, and our student participation rubric. The goal of this didactic is to increase student understanding and allow students to apply dermatology knowledge. This didactic takes the student through a case in which a 29 year old female comes to the clinic with a new skin lesion on her leg. The students are asked to develop differential diagnoses, obtain a hypothesis-driven history, define dermatology terms, use dermatology terms to describe a skin lesion, and recommend treatment options.

Chronic Disease Management-Longitudinal Selective

Description of Resource: During the required Third Year Paul L Foster School of Medicine at TTUHSC-El Paso Family Medicine--Surgery Clerkship 15 week Block Rotation each student rotates through weekly 4 hour sessions in assigned Longitudinal Selectives, a commitment honored whether the student is rotating on Family Medicine or Surgery. The goal of the Chronic Disease Management Selective is for students to develop and demonstrate competency in investigating and utilizing evidence-based clinical support systems for the chronic condition being considered and in assisting patients develop their own self-management skills. This is accomplished through clinic sessions with faculty, assigned readings, a series of home visits with a selected patient, neighborhood "windshield" tours and identification of social and community resources. Students are expected to submit a complete report by the end of the Selective to the supervising faculty for their end of selective evaluation. Any patient comments from the home visit or clinic sessions are included in the final assessment of the student. During Orientation, students review the presentation "Improving Chronic Illness Care: Chronic Care Model" (Appendix A) with faculty. The STFM Family Medicine Clerkship Curriculum (Appendix B) section on Chronic Illnesses is used for the course. Students are then paired with experienced clinicians during continuity clinics one afternoon each week at the beginning of the selective to learn chronic disease management. They receive current reading assignments on evidence-based guidelines on conditions to be covered. During the first few weeks, students choose patients that they identify as needing help in self management for a chronic condition. Faculty obtain verbal permission from the selected family. Thereafter, the student makes his/her own arrangements for the home visit.